Modeling Condition chronicity

In some situations it’s useful to know whether a particular Condition is chronic or not. I didn’t see an obvious way to model that.

Is there an existing way to indicate chronicity? If not, would it make sense to submit an enhancement tracker to add that? I can see several potential approaches, in order of specificity.

  1. Add a new Condition.chronic element with cardinality 0…1 and type boolean
  2. Add a new Condition.chronicity element with cardinality 0…1 and type CodeableConcept, with extensible binding to a new value set containing codes such as “acute” and “chronic”
  3. Expand the existing condition-clinical value set with additional level 1 codes for “acute” and “chronic”
  4. Add a new Condition.qualifier element with cardinality 0…* and type CodeableConcept with preferred binding to a new value set derived from the SNOMED CT qualifier values (would allow for any qualifier, not just chronicity)

It might be worth logging a change request to solicit more feedback from Patient Care on this question, but I will add that there has been some discussion in the past that implied some might be using pre-coordinated condition codes to make that distinction. For example:

Acute otitis media (disorder)
SCTID: 3110003

Chronic otitis media (disorder)
SCTID: 21186006

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I created new tracker 20358 for Condition chronicity. If you can add it a Patient Care conference call agenda at some point after HIMSS then I’ll try to join the discussion.

Using coordinated condition codes can work in some circumstances but I don’t think it will be an adequate general solution. I’m leery of parsing concept code description text to look for string patterns like “Acute” or “Chronic”. In the US realm for payers we typically get conditions with only single ICD-10-CM codes without any SNOMED codes.

I’ll add it to the agenda on Thurs, Feb 21.

Extending my example from earlier, ICD-10-CM has different codes for acute vs chronic otitis media as well. I wasn’t suggesting that you parse text, but rather have terminology capabilities that aid the understanding of the precoordinated ICD-10 or SNOMED codes.

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Concepts are complex for acute vs chronic vs persistent. For some conditions there are defined time periods that distinguish acute from chronic. Most there is not. There is ambiguity about whether a relapsing condition is chronic or intermittent. Precoordinated codes of SNOMED or ICD-10 don resolve the ambiguities in many cases.

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Thanks Russ I appreciate the clinician input. Do you have any specific thoughts on how to enhance the Condition resource or associated value sets to better represent chronicity?

The two ends of the spectrum seem easy. Things that are self limited are acute, regardless of the time frame: viral respiratory infection, pneumococcal pneumonia, acute allergic reaction, broken wrist. Longstanding chronic conditions are easy: diabetes treated for twenty years, chronic kidney disease. But what about a chronic condition that resolves: cancer that is cured surgically, hepatitis C successfully treated, childhood asthma that resolves. And I think the most difficult to classify are relapsing conditions. How do you label the chronicity of a propensity, like an allergy or asthma, palindromic arthritis?

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Would you agree that the right general approach is to expand the existing condition-clinical value set bound to the Condition.clinicalStatus element with additional codes for chronicity? I understand that identifying the optimal set of codes for chronicity will be challenging, but before we get into that I want to figure out whether to use that value set as a starting point or add a completely new element.

I think that is a reasonable place to start.

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As a reminder, this is on the Patient Care agenda to discuss tonight (Feb 21) at 5pm Eastern.

As a follow-up, Patient Care voted on GF#20358 and concluded:

  1. a pre-coordinated code is recommended to be consistent with CCDA
  2. due to implementers having some support for an acute/chronic flag (although it was debatable whether users actually use the flag), Patient Care agreed to add an extension for disease-course
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Hello, do you have any idea on how to record the onset date of chronic condition? I mean a chronic condition can have 2 onset dates. One for first the patient is diagnosed with this condition (… years ago), one for the relapse of the condition (a few days ago). My only solution is to create 2 condition for both of them. 1 for chronic condition itself with first diagnosed date on Condition.onset element and ClinicalStatus of “active”. 1 for relapse of this condition and relapse date on Condition.onset and ClinicalStatus of “relapse”. Can you please give any comment on that?

Two conditions is one option. The other is to look back at history to see what’s happened over time. I’ve asked Patient Care if they have any additional guidance

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I’ll try to squeeze this into the Patient Care agenda this week (Thurs, Oct 10 at 5pm Eastern).

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Sorry for the delay getting back to you. Patient Care did discuss this briefly on Oct 10. We confirmed that the current onset is meant to represent the first time the condition was diagnosed (not the onset date of the relapse). The relapse date is a gap and Patient Care encourages you to submit a change request to add support for the date of relapse.

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